Most recently, 1.5 million people died each year as a result of tuberculosis infection, 98 percent of them in developing and emerging countries.
Photo: dp/Anupam Nath
There was a moderate sensation when MSF reported a breakthrough in the treatment of multidrug-resistant tuberculosis (MDR-TB) at a symposium at the Union’s 52nd World Conference on Lung Health in autumn 2021. After decades of little action in this area, the NGO spoke of the “beginning of a new chapter for people currently confronted with lengthy and ineffective treatment regimens.”
Actually, Doctors Without Borders provides medical emergency aid in the crisis and war zones of the world. But now, for the first time since it was founded in France in 1971, MSF has conducted a clinical drug study on its own. The fact that an NGO funded by donations is taking over the work of the pharmaceutical industry indicates their disinterest in diseases that primarily afflict poor countries.
This includes tuberculosis. For decades, it has been the infectious disease with the highest number of deaths worldwide. Most recently, 1.5 million people died as a result, 98 percent of them in developing and emerging countries. 6.5 million acute cases of “open TB” are currently estimated. The only vaccine available is outdated. Treatment has been with the same antibiotics for decades. For this reason, drug resistance developed, which is difficult to master. MDR-TB, which is resistant to two standard antibiotics, is treated with a drug cocktail of up to 14,000 tablets per person. This is grueling for those affected and a real ordeal. The treatment lasts 20 months and sometimes has to take place in the hospital under medical supervision, as painful injections are administered for several months. The side effects are serious, it is not uncommon for hearing loss and mental or kidney dysfunction to occur. And the success rate of the treatment is not particularly high.
As the main private organization involved in TB treatment, MSF knows these issues from its direct work. Most recently, MSF doctors supported around 17,000 therapies every year, including a good 2,000 against MDR-TB. Bern-Thomas Nyang’wa, a doctor from Malawi in south-east Africa, has learned from years of work in hospitals that treatment, not only for tuberculosis, is lacking exactly where it is most urgently needed. And that problems have to be solved somehow, even with unusual measures. And so it was above all Nyang’wa, the first medical director with black African roots at MSF, with his perseverance that ensured that the NGO carried out the complex clinical study.
This was made possible by the development of several new drugs, co-financed by the private-state TB Alliance, in the early 2010s, including the drug bedaquiline, one with a completely new mechanism of action for the first time in 40 years. At first, this was nothing more than a glimmer of hope, as the drug was scarcely available in the global south and there were no clear guidelines for its use. MSF launched TB-Practecal in 2017 to determine what the best treatment regimen might be. In the randomized and strictly controlled clinical trial, three combinations were tested, with the regimen containing bedaquiline, pretomanid, linezolid and moxifloxacin proving to be “the most effective and safest.” In the crucial phase II/III, 552 patients with MDR-TB took part at seven sites in Belarus, South Africa and Uzbekistan. Result: 89 percent could be cured – compared to 52 percent with the previous treatment. In addition, the purely oral therapy with only three to five pills per day also has significantly fewer side effects and only lasts six months. The results were promptly shared with the World Health Organization (WHO) and summarized in a study that was published in the New England Journal of Medicine at the end of December 2022 after independent expert review. The WHO has now formulated the treatment scheme as a guideline. Such recommendations for medical practice are implemented particularly in countries of the Global South with rudimentary test structures. Thirteen countries are said to be adopting the regimen later this year.
Of course, MSF medic Nyang’wa, now a science award-winner, knows there’s only one more hurdle to overcome. “Nearly half a million people get MDR-TB every year, but I don’t think even a thousand are getting the new treatment right now,” he says. if it was covide, “such a dramatic change in treatment would have been introduced overnight.” In his view, there is a lack of political will and investment.
Doctors Without Borders is calling for the price for the six-month treatment to be reduced from around $600 to a maximum of $500. This is aimed primarily at the pharmaceutical manufacturer Janssen. After all, the European subsidiary of the US group Johnson & Johnson received considerable funds from public and non-profit organizations for the development of bedaquiline. With this drug, treatment in poor countries currently costs $270, although experts say $102 would still be profitable. Nyang’wa’s demand is clear: “Now it’s important that the new treatment is made available to everyone who needs it.”